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General NPI Number Information
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NPI Number | 1326484106
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Entity Type | Individual
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Provider Name | KAYLA MARJORIE HENRY PA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 315 S MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12208-1707
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Country | US
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Telephone | 518-525-1550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14890
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City | ALBANY
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State | NY
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Zip | 12212-4890
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Country | US
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Telephone | 518-525-5634
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Fax | 518-649-4094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 021489
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 243U00000X
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Taxonomy Name | Radiology Practitioner Assistant
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License Number | R000195
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License Number State | NY
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